Patient Safety and Quality Improvement
The Patient Safety and Quality Improvement domain tests how you prevent harm, report errors and near misses, and use improvement methods. Expect questions on safety culture, root cause analysis versus failure mode and effects analysis, bundles, and the nurse's response after an error.
Core rules and concepts
- A just culture separates human error (console), at-risk behavior (coach), and reckless behavior (sanction). Reporting is encouraged; near misses are reported because they reveal system hazards.
- A sentinel event is an unexpected death or serious permanent harm. Root cause analysis (RCA) is retrospective. Failure mode and effects analysis (FMEA) is prospective, used before a process starts.
- PDSA (Plan-Do-Study-Act) cycles test small changes before spread.
- Use two patient identifiers, hand hygiene, procedural time-outs, medication reconciliation, and evidence-based bundles for central lines, urinary catheters, and ventilators.
- Assess fall risk, for example with the Morse scale, and pressure injury risk with the Braden scale; implement individualized prevention.
- Complete an incident report per policy for errors and near misses. The report is a quality document; do not file it in the medical record, and document only objective facts and notifications in the chart.
Worked example
A nurse administers a dose to the wrong patient but the patient remains stable. Priorities are to assess the patient, notify the provider, monitor for adverse effects, and document the assessment and notification objectively. She then completes an incident report through the safety system, informs the manager, and participates in disclosure per policy. She does not write 'incident report filed' in the progress note, and the focus is system learning, not blame.
Traps that cost marks
- Putting the incident report in the chart or copying it into the note.
- Choosing FMEA for an event that already happened; RCA is retrospective.
- Assuming no harm means no report; near misses count.
- Using restraints as a fall-prevention shortcut.